Benign Characteristics Gross Micro Dx* Tx

Most common benign – Red-blue nodules. Vascular channels in a bed of CT: Arterial centripetal Don’t do Biopsy – Asymptomatic: Obser
hepatic neoplasm. – < 2 cm in diameter. fibrous connective tissue. enhancement => Late venous
Cavernous Hemangioma
F>M – Located directly beneath the washout.
capsule.
OCP/Anabolic steroids – – Pale, yellow-tan or bile- Sheets & cords of hepatocytes Resection
Malignant degeneration. stained nodules. with variation in cell & nuclear
Adenoma – Often subcapsular. size.
– Most are solitary.
Portal tracts are absent.
Benign. – Well-demarcated nodule. Hepatocyte nodules are CT / MRI: Central Stellate Scar. Observe
Young to middle-aged adults. – Lighter than surrounding liver surrounded by fibrous septa.
Focal Nodular Hyperplasia Secondary to altered hepatic or yellow.
blood supply. – Central gray-white stellate
scar with radiating septa.
Malignant Characteristics Gross Micro Dx Tx
Cirrhosis – Child Mass: HCCs range from well CT: early arterial enhancement – Surgery (resection) curative
Classification (BANANA) AFP – Unifocal (usually large) mass differentiated to highly => Early venous washout. – Radiofrequency ablation
– Alpha Foeto Protein. –Multifocal anaplastic undifferentiated – Chemoembolization
Male predominance. – Color paler than normal liver/ lesions.
LIVER – Increased due to HCV green. Resection – Transplant– Medical
Hepatocellular
NEOPLASMS chronic infection
Carcinoma/Hepatoma
Malignant •Strong propensity for invasion
of vascular structures:
Extend into the portal vein or
inferior vena cava (up to right
heart)
P
Young childhood (90% in 1st 5 Chemotherapy & complete surgical rese
R
years of life).
I
Associations:
M
– Prematurity
R
Hepatoblastoma – Glycogen storage disease
Y
– Syndromes (Beckwith-
Wiedermann, Familial
adenomatosis polyposis
syndrome)
• Distinctive variant of HCC Single large hard "scirrhous" Well-differentiated polygonal
• Young adult (20-40 years) tumor with fibrous bands cells growing in nests or cords,
• No sex predilection and separated by parallel
Fibrolamellar carcinoma • No underlying chronic liver lamellae of dense collagen
diseases. bundles.
• Prognosis better than
conventional HCC
 1) Intrahepatic: Hilar Microscopy: 1) Intrahepatic: Hilar (Klatskin) => Surge
(Klatskin).
• Adenocarcinoma 2) Extrahepatic: More common-Bismuth
2) Extrahepatic: More • Marked desmoplasia Not a candidate for surgery.
common-Bismuth Class. • Premalignant lesion:
Cholangio- carcinoma Biliary intraepithelial
neoplasia.
• Lymph node metastasis &
hematogenous metastases
(lungs, vertebrae, adrenals,
brain)
Most common hepatic Workup: Upper & Lower Resection – Control Primary / Adequate
malignancy. Endoscopies – Mammo – Staged resection: PVE.
S
Thyroid US.
E
1) Distant: GI/ GU/ Genital Pan CT ‐ Markers
C
Malignancies.
O
METASTATIC LIVER Rarely: Breast /lung.
N
NEOPLASMS
D
2) Local Extension: GB/
A
Gastric /Colonic.
R
Y